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Maria v. Dura Mark

March 5, 2012

MARIA GOMEZ, CLAIMANT-APPELLANT,
v.
DURA MARK, INC., EMPLOYER, AND STATE INSURANCE FUND, SURETY, DEFENDANTS-RESPONDENTS.



Appeal from the Industrial Commission.

The opinion of the court was delivered by: Burdick, Chief Justice

2012 Opinion No. 44

Stephen W. Kenyon, Clerk

Industrial Commission Order Denying Reconsideration, affirmed.

This case concerns an appeal of an Order Denying Reconsideration by the Industrial Commission of Appellant Maria Gomez's motion to reopen the record to allow for additional evidence on the issue of causation. The Industrial Commission previously ordered that Gomez had failed to prove the medical treatment she received for a back injury was related to an industrial accident and injury. At the emergency hearing pursuant to the Judicial Rules of Practice and Procedure adopted by the Commission, Gomez introduced evidence regarding her entitlement to reasonable and necessary medical care pursuant to I.C. § 72-432, but the referee denied Gomez's claim on the grounds of causation. We affirm the Commission's judgment. In doing so, this Court wishes to provide a clear message that without a specific stipulation that causation will be a contested issue at the hearing pursuant to I.C. § 72-713, and especially if there is a difference of opinion as to causation by opposing parties and their experts, claimant's attorneys should no longer be lulled by anything other than a stipulation to all legal prerequisites and elements for recovery and be prepared to present evidence of a causal connection between the industrial injury or sickness and the required treatment.

I. FACTUAL AND PROCEDURAL BACKGROUND

On June 28, 2010, Appellant Maria Gomez (Gomez) filed a Worker's Compensation Complaint with the Industrial Commission (Commission) claiming benefits for an accident that occurred on July 24, 2009, when she injured her lower back lifting sixty-pound boxes. The injury occurred at Blackfoot Brass (Dura Mark). Gomez had previously suffered two work- related accidents while working with Dura Mark, one in 2002, the other in 2006, but had returned to work without restrictions after participating in physical therapy for both injuries.

In November 2009, Dr. W. Scott Huneycutt diagnosed Gomez with a "herniated lumber [sic] disk with radiculopathy and low back pain." As for causation, Dr. Huneycutt indicated that he would defer to a physical medicine specialist for any determination of causality or disability. Dr. Huneycutt referred Gomez to a physiatrist and pain management specialist, Dr. Jake Poulter. Dr. Poulter reviewed Gomez's MRI in December 2009, and concluded that she had a "disc protrusion at the L4-L5 level with a bilateral lateral recess narrowing" and a "small disc bulge at the L5-S1 level," together with "impingement of the exiting nerve root on the L4-L5 level" caused by the disc bulge. On February 16, 2010, Dura Mark's surety, the State Insurance Fund (Surety) sent Gomez to see Dr. David Simon for an independent medical exam. At this time she had finished the physical therapy prescribed by Dr. Poulter. After examining Gomez and reviewing her medical records, Dr. Simon found symptoms inconsistently related to a disk herniation and radiculopathy as well as exaggerated pain behaviors, and concluded that she could return to work without restrictions regarding the work-related injury. The Surety then had Dr. Paul Montalbano review Gomez's medical records and MRI, who concluded Gomez needed no further treatment for the work-related injury.

A week after her examination by Dr. Simon, Gomez returned to Dr. Poulter, complaining of persistent pain that prevented her return to work. Starting March 18, 2010, Gomez stopped receiving disability benefits. Dr. Poulter then wrote a letter to the Industrial Commission Rehabilitation Division in Idaho Falls stating that he did not agree with Dr. Simon's findings and that Gomez was not ready to return to work. After Gomez's request for an emergency hearing, the Industrial Commission assigned the matter to a referee and the hearing was held October 6, 2010.

The referee filed his findings on January 31, 2011, stating that he was perplexed by the "significant difference of opinion over the interpretation of [Gomez's] MRI study." The referee was persuaded more by the opinions of Dr. Simon, Dr. Montalbano, and the original radiologist that reviewed the MRI, stating the record did not reveal the bases for Dr. Huneycutt's and Dr. Poulter's reading of the MRI. In conclusion, the referee found that Gomez had failed to show that the treatment received was causally related to a condition triggered by the work-related injury. Therefore, the referee concluded that no analysis pursuant to Sprague*fn1 was needed to determine whether her treatment was reasonable and necessary.

After the Commission adopted the referee's findings, Gomez filed a motion for reconsideration asking that the record be reopened to allow for additional evidence on the issue of causation, arguing that no notice was given for the issue of causation and that causation had been established earlier in the case because neither party raised it as an issue. In its Order Denying Reconsideration, the Commission stated that Gomez was correct that they had not reached the question of reasonableness of treatment, but had based its decision on causation. The Commission based its ruling on Henderson v. McCain Foods, Inc., 142 Idaho 559, 130 P.2d 1097 (2006), and claimed that Gomez was on notice of her requirement "to establish causation as a crucial element of her request for additional medical benefits." The Commission further found that causation had not been conceded by Dura Mark as the parties' experts were in disagreement about whether Gomez's symptoms were caused by her industrial accident. Gomez timely appealed.

II. STANDARD OF REVIEW

The Idaho Constitution limits this Court's review of appeals from the Industrial Commission to questions of law. Idaho Const. Art. V, ยง 9; Sprague v. Caldwell Transp., Inc., 116 Idaho 720, 721, 779 P.2d 395, 396 (1989). Idaho Code section 72-732 allows ...


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